Schultz, Aaron R���i1�E�
�UL �7 '`'�`�
�,u�.D
CI�"Y �L�RK
NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minnesata State Statute 466.05 states that"...cvery person...who claim.s damages from m�y municipaTiry...,s�rall cause to be prestnted to the
goyernyg body of the manicipaliry within 180 days Q/ter the aTkged lass ar injury is drscovered a notice statvig die t�►ee,Piace.and
circum.stancas thereof,ancl tlu amowu of compensation or other nlief demanded"
PleaAe complete this form in its entirety by ckarly ty]i�►g or printing your answer to esch question. If more space is
needed,attach additional s6eets. Pleese note that you an11 not be contacted by telephone to darify answers,so provide as
mnch information as nece,9sary to explair►yonr claim,and the amoant of compensation being recNested. Yoa will receive a
written aclawwledgement once your form is received. The proccss can leke aP to ten weeka or longer depending on the
nature of your daim. 'I7�is form mast be signed,and boW pages completed. If someW6�g does not aPP�Y�write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK,
, 15 WEST KELLOGG BLVD,310 CITY HALL, SAINT PAUL,MN 55102
�r�yr�S�S��� 1���I�(.� InS. AIS/i: �Chv'���7
First Name 1�rl r�n _ Middle Initial Last Name
Company or$usiness Name
Are You an Insurance Company Yesy No If Yes,Claim Number? �. `f - 3`,� ���1� �`
StreetAddress �� � �� — � ����
City��:.5�.�1J'l;� S � State�1� 7ip Code �I UC`�I�C����l
Daylime Phone(`7�v) ��V- �Z�C�ll Phone(� - Evening Telephone�_) -
Date of Accidend Injury or Date Discovered I���7�/�� Time 3 '�� am,�
Please state,in detail,what occurretl(happened),and why you are submitting a claim.Please indicate why or how you
feel the City of Saint Paul or its employees are involved and/or responsible for your damages.
' l' /„
Please check the box(es)that most closely repnesent the reason for completing this form:
�My vehicle was damaged in an accident ❑My vehicle was damaged during a tow
�My vehicle was damaged by a pothole or condition of the street ❑My vehicle was damaged by a plow
�My vehicle was wrongfully towed and/or ticketed ❑I was injured on City property
�Other type of property damage—please specify
�Other type of injury—please specify
In order to process your claim yon nced to include wnies of all applicable docurnents.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a
copy for yourself before submitUing your claim form.
O Property damage claims to a vehicle:two estimates for the repairs to yow vehicle if the damage exceeds
$500.00;or the actual bills and/or receipts for the repairs
O Towing claims:legible copies of any ticket issued and a capy of tt�e impound lot receipt
O Other property damage claims:two repair estimates if the clamage exceeds$500.00;or the actual bills
and/or receipts for the repairs;detailed list of damaged items
O Injury claims:medical bills,receipts
O Photographs aze always welcome to document and support your claim but will not be returned.
Page 1 of 2—Please comglete and return both pages oP Claim Form
Failure to complete and return both gages wII1 result in delay in the handling of pour claim.
All Claims—ulease comulete this sechion
Were there witnesses to the i�ident? Yes No Unknown (circle)
Provide their names,addresses and telephone numbers:
�
Were the police or law enforcement called? _ es' No Unknown (circle)
If yes,what department or agency? � i� � Case#or report# I y��li,�,�,���
Where did the accident or injury take place? Provide street address,cross street,intersection,name of park or facility,
closest landmark,etc. Please be as detailed as ossible. If necessary,attach a diagram,
� '�i 5 f"(i S`1" �S�- I�CL�'� �X ►'t"
Please indicate the amount y are seeking in compensation or what you would like the Caty to do to resolve this claim
to your satisfaction. ����3�� �1/
Vehicle Claims—ulease c�om lete this section ❑c k box if this section dces not a 1
Your Vehicle: Year 3C�1�l Make � 61, Model �t �j� l,
License Plate Number State Color
Regi stered Owner��(f'�u(1 [:.f i i:i t Z-
Driver of Vehicle '
Area Damage�d - �' °
City Vehicle: Year .�,%'1�Make Y �� Model I ►�n n�� j�
License Plate Number 7f v�.1 f� � State�'' Color [�1�+"�
Driver of Vehicle(Ci F�nployee's Name)f�r�1?��y,it h �-^-�
Area Damaged�C�i'1�
Iniur�Claims—please complete this secl3on �l�check box if this section dces not annlv
How were you injured?
What part(s}of your body were injured?
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive tream�ent7 (provide date(s})
Natne of Medical Provider(s}:
Address Telephone
Did you miss work as a result of your injury? Yes No
When did you miss work? (provide date(s}}
Name of your Employer:
Address Telephone
❑Check here if you are attaching more pages to this claim form. Number of additional gages
By signing this forny you are stating that adt informatiori you have provrded�s true and correct to the best
of your kraowdedge. Unsigned forms will not be processed
Submitting a false claim can result in prosecrction. Date fo mpleted � � �
Print the Name of the Person who Completed ' o l� �D� ��G ��
°�
Signature of Penson Making the Claim: s�� �
xevised Febru�y 2011 � �
Our narned insured's 2014 Volkswagen Passat was traveling on I-35 east. A City of St Paul
2010 Chevrolet Irnpala, license plate#767JHB, was traveling on I-35 east. As our insured's
vehicle stopped due to traffic, the 2010 Chevrolet Irnpala rear-ended a 2010 Ford F-150,which
rear-ended our insured's vehicle. The driver, Bobby Donahue, is the proximate cause of the
accident for following too closely.
�/�i��������+/�
Payment Address Document Address
24344 Network Place P.O. Box 512929
Chicago, IL 6Q673-1243 Los Angeles, Ca 90051
Phone:(877)818-0139
Fax: (888)781-6947
7/1/2015 10:39:00 AM
Certified Mail 91 7199 9991 7035 3566 4814 Return Receipt Requested
CITY OF ST PAUL
CITY CLERK OFFICE
310 CITY HALL
15 WEST KELLOGG BLVD
ST PAUL MN 55102
Your Client: DONAHUE, BOBBY
Your Claim Nurnber:N/A
Our Insured:SCHULTZ, AARON
Our Claim Number:l4-3448436
Arnount Subject to Reirnbursernent:838.11
Arnount of Insured's Deductible:WAIVED
Please take this as forrnal notice of our subrogation rights relative to the above -captioned
clairn. We have completed our investigation into the facts of the above-captioned loss and find
that your insured was the proximate cause of the accident.
Location of Loss: I-35 EAST/ ST PAUL EXIT IN ST. PAUL
Date and Tirne of Loss:10-07-14 AT 3:15PM
Description of Loss: Our narned insured's 2014 Volkswagen Passat was traveling on I-35 east.
A City of St Paul 2010 Chevrolet Irnpala, license plate#767JHB, was traveling on I-35 east. As
our insured's vehicle stopped due to traffic, the 2010 Chevrolet Irnpala rear-ended a 2010 Ford
F-150, which rear-ended our insured's vehicle. The driver, Bobby Donahue, is the proximate
cause of the accident for following too closely.
Please make your draft payable to Progressive Direct Insurance Co as subrogee of
"SCHULTZ, AARON °, in the arnount stated above and mail it to the attention of the
undersigned at your earliest convenience. All supporting docurnentation is enclosed. I have
diaried rny file ahead fifte n (15) days. Thank you for your anticipated, prornpt attention to this
rnatter.
.
�--�'" _.
Christopher Woolfolk
Subrogation Representative
Progressive Direct Insurance Co
Tel. 440-910-5505
Fax. 888-781-6947
Ernail: Christopher Woolfolk�,dprogressive.corn
Claim 1'avment lletail Y�i��e 1 of�1
�f�i�rs ���ta��€�� ����€� � ���,.��������� °�
;-Payment Information ----------------------------------------------------------------°--------------------------------_____---_______-__----�
Disbursement Number: 328177482 Total Amount: $838.11
Draft Number: 2008032963 Invoice Number: 16757568
Pay to the Order of: AARON D SCHULTZ AND LAMETTRYS COLLISION INC
Mailing Address: 4700 S ROBERT TRL
INVER GROVE HEIGHTS,MN 55077 US
In Payment Of: Progressive Invoice Number:16757568
r.�Review�ed Summa ____.___,_.__. ..__._.__ ____ _________ _______ _.___.___ _.__.__._ .-------- .__._..__ _--------._._.,
ry_____.___.___...
Issuing Rep: A093085 Approved By:
Issue Date: 04-0&15 Review Date:
Last Updated Rep: A093085 Reviewed By:
;--Bank Information ------------------------------------------------__�_----------------------------------------------------------------------------------,
Type: LOSS Bank Code: 1CD
Stop Reason• Cleared: 04-if'r15
Stop Date:
___.._--- .__,.._ _ _____ _---- ___. _.__ _ ____ ____ ---_..
-Exposure Detail:COLL--------- -- ----- --- ----- - - ----- - -- --- ---- -------- —---------,
Party Name: SCHULTZ,AARON D Amount Paid: $838.11
! Property Description: 14 VOLKSWAGEN PASSAT Deductible Taken: $0.00
Payment Type: FINAL PAYMENT Property Damage: $0.00
Rental: $0.00
http://claiinspayments/Sravo/ClaimsPayments Web/default.aspx?page=ClaimPaymentDetail... 7/1/2015
Date: 417/2015 03:59 PM
Estimate ID: 14-3448436-01
Estim�e Version: D
Committed
Prafile ID: Melro AIIExcept7.125
Progressive Direct Insurance Co
Damage Assessed By: CODEY W ITTIG `Claim Rep: Codey W ittig
(672)655-1039
ClassiFication:
'Product Type Auro
'Date of Loss: 10/7/2014
'Deductible: 1,000.00
'Claim Number: 14-3448436-01
Insured: AARON SCHULTZ
Owner: AARON SCHULTZ
Address: 36080�UINLAN AVE,CENTER CITY,MN 55012
Telephone: Home Phone: {651)356-2688 Cell Phone: (651)260 3653
Contact Phone: (851)260-3653
Mitchell Service: 911103
Description: 2014 Volkswagen Passat SE Vehicle Production Date: 3/14
Body Style: 4D Sed Drive Train: 2AL Turbo Inj 4 Cyl 6sl 8A FW D
VIN: 1VWBN7A35EC085481 Licvise: 589NEU MN
Mileage: 27,525
OEM/ALT: A Search Code: ARDENHILL2
Color: GRAY
Optians: PASSENGER AIRBAG,POWER DRIVER SEAT,POW ER LOCK POW ER W INDOW,POW ER STEERING
REAR WINDOW DEFOGGER,AIR CONDITIONING,CRUISE CONTROL,TILT STEERING COLUMN
AMlFM STEREO,DRIVER AIRBAG,HEATED EXTERIOR MIRROR
FRONT SIDE AIRBAG W ITH HEAD PROTECTION,ANTI-LOCK BRAKE SYS.,TRACTION CONTROL
ALUM/ALLOY WHEELS,REARVIEW CAMERA,TIRE WRATION/PRESSURE MONITOR
NAVIGATION SYSTEM,AUXILIARY INPUT,BLUETOOTH W IRELESS CONNECTIVITY,HD RADIO
LEATHER STEERING WHEEL,SATELLITE RADIO,CD P�AYER
POW ER ADJUSTABLE EXTERIOR MIRROR,SUN ROOFMIOONROOF,TRIP COMPUTER
FIRST ROW BUCKET SEAT,TELEMATIC SYSTEMS,SIDE AIRBAGS,AUTOMATIC HEADLIGHTS
SECOND ROW SIDE AIRBAG W ITH HEAD PROTECTfON
INTERIOR AUlOMATIC DAY/NIGHT OR ELECTROCHROMATIC MIRROR,MP3 PLAYER
DAYTIME RUNNING LIGHTS,DRIVER SEAT W ITH POWER LUMBAR SUPPORT
ELEClRONIC STABILITY CONTROL,FRONT HEATED SEATS
FRONT SEATS WITH POWER LUMBAR SUPPORT,KEYLESS[NTRY SYSTEM,REAR BENCH SEAT
STEERING WHEELAUDIOCONTROLS
Line Entry Laba Line Rem Part Typei Dollar Labor
kem Numba Type OperaHon Description ParWumber Amourit UnRs _
Reer Bumner
1 BDY OVERHAUL Rear Bumper Cover Assy 3.0 #
2 101662 BDY REMOVE/REP�ACE Rear 8umper Cover Rananufactured 319.00 INC #
3 RE F REFINISH Rear Bumpar Coner C 2.6
4 101666 BDY REMOVE/INSTALL Rear Lwr Bumper Valance Pand EnisGng INC r
5 936012 ADD'LCOST HAZARDOUS WASTE DISPOSAL 3•S� '
ADDITIONAL OPERATIONS
6 REF ADDL OPR Clear Coat ���
Addklonal Costs d�Maierlals
7 ADD'L COST PainUMa4aials 122.40 `
8 900500 REF' REMOVE/REPLACE FLEX ADDITIVE °Non-OEM 5.00 ' 0.0'
*-Judgment ftem
#-Labor Note Appl ies
"*Non-OEM -Non-Original Equipment Manufacturer Replacement Part
C-Included In Clear Coat Calc
r-CEG R&R Time Used For This Labor Operation �
ESTIMATE RECALL NUMBER: 04I07/2015 15:59:13 14-3446436-01
Mitchell Data Version: OEM: MAR 75 V0403
MAPP:MAR 15 V0405 Copyright(C)1994-2015 MRchell International Page 1 of 4
Sokware Version: 7.1.177 All Rights Reserved
Date: 4/7/2015 03:59 PM
Estimate ID: 14-3448436-01
Es6m�e Version: 0
Committed
ProfilelD: Me[roAllExcept7.t25
KEYSTONE-INS QUALITY PRT
3615 MARSHALL ST.NE
MINNEAPOLIS
MN 55478
{soo�s2e-ieas �s�2}�es iaes
2 "VW 1100192R 319.00
Al1 manufacturers requirements regarding seat belt and supplemental
restraint system replacement must be adhered to. If additional parts
or operations are necessary to properly accomplish this, please
contact the estimating claims rep.
Estimate Totals
Add'I
�abor Sublet
L Labor Subtotals Unrts Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 3.0 54.00 0.00 0.00 162.00 Taxable Par[s 324.00
Refinish 3.6 54.00 0.00 C.00 194AC Sales Tax �a 7.125% 23.09
Non-Taxade Labor 356.40 Total Replacemerrt Parts Amount 347.09
Labor Summary 6.6 356.40
III. Additional Costs Amount IV. Adjustments Amount
Taxade Costs 122.40 Insurance Dedudide 1,000.00-
Sales Tax @ �.725% SJ2 Subtotal of AdJustmenis Exceeds Gross Total
Non-Tauable Costs 3.50 Customer ResponsibilRy 838.11-
Total Adddional Costs 134.62
Paint M�aial Method:Ratas
Init Rate-34.00
L Total Labor: 356.40
II. Totai Replacem�t Parts: 347.09
III. Total Add'Rional Costs: 134.62
Gross Total: 838.11
IV. Total Adjustments: 838.11-
Ne[Total: 0.00
PoirA{s)of Impad
6 Rear Center{P)
AI4 Location: PROGRESSIVE
Inspaction Si[e: LAMETTRY'S COLLISION INVER GROVE HEIGHTS
Address: 4700 S Robert Trail
Invar Grwe HeigMs,MN 55077
{651)286-3921
Inspection Date: 4i 7I2015
�I
ESTIMATE RECALL NUMBER: 04/07/2015 15:59:13 14-3448436-01
Mitchell Data Version: OEM: MAR 75 V0403
MAPP:MAR 15 V0405 Copyright(C)7994-2015 Mitchall Intemational Page 2 of 4
Sokware Varsion: 7.1.177 All F2ights Reserved
Date: 4/7/2015 03:59 PM
Estimate ID: 74-3449436-01
Estima[e Version: 0
Committed
Pro(ile ID: Mdro AIIExcept7.125
THIS IS A DAMZIGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR -
BASED ON DAMAGE VISIBZE OR CERTAIN AT THE TIME IT WAS WRITTEN.
IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT
SHOWN INCLUDES TIME OR ALIAWANCE FOR MEASURING BEFORE, DURING AND
AFTER THOSE REPAIRS.
THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HER
CHOICE.
TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED
DURING THE COURSE OF REPAIRS, CONTACT PROGRESSI�7E FOR SUPPLEMENT
HANDI�ING PROCEDURES.
PROGRESSIVE HONORS THE PREVAILING LABOR MARKET RATE IN YOUR AREA FOR
YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF ,
PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE
DIFFERENCE.
LIFETIME GUARANTEE FOR SHEET METAI, AND PLASTIC BODY PARTS
The replacement parts written on the estimate are intended to return
your vehicle to its pre-loss condition with proper installation.
After repair, if any sheet metal or plastic body part included in the
estimate fails to return your vehicle to its pre-loss condition
(assuming proper installation) , in terms of form, fit, finish,
durability or functionality, Progressive will arrange and pay for the
replacement of the part, to the extent not covered by a ,
manufacturer's or other warranty. This service will be per£ormed at
no co�t to you (including associated repair and rental car costs) . To
obtain service under this Guarantee, call Progressive at
1-B00-274-4641. This Guarantee appliea as long as you own or lease
the vehicle. This Guarantee is not transferable and terminates if you
sell or otherwise transfer your vehicle.
THIS GUARANTEE DOES NOT COVER NORMAL WEAR AND TEAR OR DAMAGE CAUSED
BY IMPROPER MAINTENANCE, NEGLECT, ABUSE OR SUBSEQUENT ACCIDENT. THIS
GUIIRANTEE IS LIMITED TO ARRANGING FOR THE SELECTION OF REPAIR PARTS
THAT WIZL RETURN YOUR VEHICLE TO ITS PRE-I,OSS CONDITION. ACCORDINGLY,
PROGRESSIVE WILL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL OR
CONSEQUENTIAL DAMAGES THAT RESULT FROM THE INSTALLATION OR USE OF
THESE PARTS. '
Part Type Terms and Abbreviations ',
NEW and OEM or part number displayed - These refer to a new, original
equipment manufacturer pazt.
NON-OEM and A/M and Qual REPL - These refer to an after-market part,
which is a new, non-original equipment manufacturer part.
USED/RECYCLED and LKQ - Theee refer to a u9ed OEM part.
REMANUFACTURED and RECOND, and RECORE - These refer to used/recycled
OEM parts that have been refurbished.
REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING
AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION
INCLUDING TOW/STORAGE CHARGES:
SHOP SIGNATURE: EST. COMPLETION DATE:
ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE/SHE IS
FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR
FILES A CZAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF
ESTIMATE RECALL NUMBER: 04/07l201515:59:13 14-3448436-01
Mitchell Data Version: OEM: MAR 15 V0403
MAPP:MAR 15 V0405 Copyiight{C)Y994-2015 Mitchell Intemationai Page 3 of 4
Sokware Varsion: 7.1.177 All Rights Reserved
Date: 4/7/2015 03:59 PM
Estimate ID: 14-3448436-01
Estim�e Version: 0
Committed
Profile ID: Metro NlExcept7.125
INSURANCE FRAUD.
Everd Log
Fle Created: 04l07/2015 11:31:21 AM
Estimate Started: 04/07l2015 03:58:19 PM
Estimate Printed: 04I07/2015 03:59:17 PM
Estimate Committed: 04;07/2015 03:59:13 PM
Estimate Uploadad: 04l07/2015 03:59:21 PM
ESTIMATE RECALL NUMBER: 04/07/2015 15:59:13 14-3448436-01
Mitchell Data Version: OEM: MAR 15 V0403
MAPP:MAR 15 V0405 Copyright{C)1994-2015 Mitchell Intemational Page 4 of 4
Sokware Version: 7.1.177 All Rights Reserved
.;�� ' p� S�OZ/L 6/90 :a�eQ pania�a�
� 1 �
�0 l d ' � t �� /
w�o
',24 08280� ;� �
�.. I�,�°�°� m.� ..,� � ,M, „�,,, .,,,_
� f �t I � U3 ItlD �D Y lp 7 ..oia ��ue "'S3o �
� _ ,.,.,� ,,,�,�,
'1 I 35E I I �' ° ��r�seM,� a _�rt Qn�]w«� g
WVffiNC I I !M!ilJl MYtlIdCL00'M . . LI LJ
WNeevs n6u.�•�e�lt r11 �...�atriNw
52 MAPLES4QOD ��}�0_. 3b0 1D LARPEN9'EUR
RnI(�i h101N11 MI16NlL�4M1Ell.l pUff CI� 0.7U*tl lW+TOM C�14a{J�uLHWO�A.i Al.w! LN:: Ple II1L 1
� �1. zo�.62236963i 7 � B o7 61 w27326733231? DiN � 01 �1
,+r.+e�,.m �� � — s« +�.e wm,r.�fsr w�earwrv nc,a�-
' �[iOBB JOE p()Np,HCjE, �0�, 41 71 DAVIll CkfFiIS7'OPyER �INCX ,09 12 8Q
��au. .ao.:r . �
( .n�n � � . oe ..��
Q1 6626 Z45TH GIRC7,'E V �Is O1 22609 ET.STOt� CT' N.; 02 21
F,r,w, �.,,.��.,K. �
fll HUGO 55038 �— — FORFST LAKE 55025 p;
R4 � m.. eorr �rrrea. ....a w�e. vu� u:..� ,� i.r.«rr �ccor. rra�a ecer wxv ncevo
O1 �Y�• M 4 04 06 05 N °"�`,." �a "�4 04 06 05 N O1
, r nre �u .w� ..o.r r wa�na nra rcw m� a+w mr. eo�wer �qw.�p� NIiMNLCf[xwti
,��,� 9,'s '� ':ys �, o°,� 9e ��'I 9e �; o�„ """""°'
�.
r�, «�,,.� �.. ,,.,,w�..�
Qf SSS EA'ERAL CdPIT�tRCxI23G N f'itERICKS CO[dSTRUCTrON N O1�
v91m OPSa � n IOOKC] ' mM0 wllYs
dZ $�T D�� S�' Yl 360p LABORE RD STE p� pZ
�ut Mkewr.nl �`— •uuMn nrxr r,�.:�rp,n.» uu..�.� oaar �tnvu
07 . 37�1N _pAUL, MN 55103 '2� O1 W13TTE BEAR LAKE, MN 55110 "'tp Ol O1
� .wia w.a owwc
OI GHEV tMP � 01 8LK FDRD• t15 Ol SIT. 05
aw:w ¢. nree +r.�aEO �K �u+c. frRa rw�am ��wic� rw.�wevw a.aw
J3 76'i'J2�a �.v _ois oi "'� """' oi a2aezv � pi5 oi oi' ' '"° '�'" 01 oz
wN.w't I .�Ln.vQ Wr�� 'GYNW
� � Poi�tr w�
, SELP NSUREJ - CIiTY �. PAUL WES2EI�N NATIONAL CFP1025979 �
oJtGO M�i�wr w NRG�lefi• uurrite�
^� � 1!At7GRENT Ii1MOLVEDA CONMEaC1A�qOiC�VpRCLE SCMDO�81�5,01l MEAO START BUS '�"�9 ��°` °�
�� ��� (�MCN6E0.TONOTXYTNE$fA7EPATAQt(�puhc�unU�.M316D.7IIr.d1El�51f). .l � �
ou*�+cac vti.cu+w 1.uarcee:wMUtew+e I cornwaw cowuereu�vs�pew�eav•�►1�wrno�R... m*r..rc.
�� �� I . � . . r�rc
m� ww I,�_ ' I un �Ea�m rwt u�e �w.n ..�cc wsw tonm��.,.aaer
I� ,I I I Q,,w, �+.wxa�a rw.wern
� ' � s O�
I�_ O�,g wanma Wriw�wlM
O c^sv
I '� : I Q,�,M rw�li�tv�ce wwMnan
,O�
��•��uu�nuua.ti..N,.�irr�ra.wav:r.Waen�wA,,:,ac.�.:�, ' 'M.�ew,�a,
ra KUONym
o�ua[0�*av�rvz'iMNr V�ar�no[4
Vc
�� � NB fSTH 35E S ewwn� � � a�
mno� N � � .. _, .. . ....... 9B
� Un1t 1 wa� Ctavellir�q N8 ISTN 35E a roachaa
. ,.._ ._._,... PP--..--:, 9---° .
,c.n. �..�� Lazpentr.�ir �?yo_ in 7}e left 1,ne. Dzitv�= st3tetl
� �r'��� �. ehet unit 2_chaoy�;d lanea..�ri_fconL o� hi�ana..h�. 9"�A
aa�oE , I I ' looked in hia reat view mirrc,c and cnr. next cning
f: , he-knew UnLL 1�•kes•stoppea.•- •Unit 1..covld.not� --• �+��
��� � stop in cirze ana tnq ftont of unit 1 crp�hed Lnto O1
'�"°` [he"rgxk"of�nr�iC'2, "'1'hz"'LozC�C! th�'Ct3ah -'"'
02` s � puanen r.ho frant of unit 2 ��to t�e re�r of un_t °�`°
wca; Cancrete 3 .. , . . ..... . ...... -.
�� lcnry ,,
�' � B81tilf� - � .. ,_...._ .. .....,. .. .
�na,
�S I�I N Un't 2 wa9 ttnv�llinq N8 I57H S�E•,7[�PrpdCriitt�j
��I.�LDet1LBl7r•Avg-��it1�Lt1e���lpf�t�ldnr�.- Url.ver_..shatod-�- 02
'j' � � that he stoppzd dvc to heavy trafiir. »nd the 4FA1a'
�rr..
. 'fr6nL cf �unSt'�1�-ecAPbea lntb- the":eer'oE"uni[� 2.
Q1� � , � Yhe,EO[Ce ol Lhr. crae� p��- OL vnit 2� �umi
- .......... , ...h�d Cha croat .. .... ....._
'0�`� into the sc�c of ur.i t 3.
i; � , .. O1
O1; + . ... .. ..... ....... ........ -�----...:
i I Uni[ 3 was travai�in7 NB ISTk 35C appsoachinu �1°
� � . .t,zrpenteur Ave�in the lel.t.lane.,..,�civer�._.... .. _. �j
,n�,,; � � , st.ated (COntinuee ai attacnCd paqe) �
• .. ....... . . _ _ _____ _.__
o1j � 01
a„�r;.. . .�ri . I wa+w ,+rt�aw�ne»
T?p CHEtiST P?lER L LOHMER 256 State Patxol 4460 ����D�
D� 0�+��
� I �
,[� +: 7t.f-__-i - ,?'z=.=� I!'i� i� �-, - - -_ i . �. ! �' yC . I - . , i �j'.
� � S LOZlL 6/90 �a�eQ pania�a�
Ca •144 8280f
Cte �r{da :70/8/2014
Ac dint N rraflve,contln ed:
!ie as:stap ed ln traR"ic and the front of unit 2 crashed into the rear ot unk 3.
►Jo I junes re repvrted on scene_ Unif 1 was towed t�om fha scene by Rapid Recovery, Unit 9 Is awned by Cily af St.
�au. : �
i
�
� � ;� •��,,
� +�- inr-,- �� � -".� I�:�i�, l .l - ti�; --�i .. _'.1 ��. - �.i�l_ . ... ..
i i 'i i r"i l�✓ ..
�r� i �. ._ IJ ��11 f ,��, i _ _ . _�_. I � JjI�F- =i, _ I =I.J.:�_ y �i . . _, . '. _
-, �
»"nD �°r❑ 03h6 T�-�ed a�p�$ 9SZ �33WFi07 Z Zi'.�IHd ZSi2�H d�l�.
mo.��aur.aNn❑ ,A,m:+�, es,�w I ��°�`� v�
h,. .... . ..... ...
, ,
�. ,..� :.. ....,�...... ��. ,
.
_... .._.._. .... ...... .......... .. ..... ._. .. ... , . .. ,...�,
: � �
... . , .... , � .... .
N/rOYG ' . . . .. .,... .. . . . , . . MIIC a
. .
, . ..... .. . .. .
... ..""'..... ._... . ............ � . r '
.
� .., .. ...... .. ..._..,.... � 'I
y „ ' .. .J .. : .. .... i . .
"' ._'_.' :....,_..._., .__... .......... _... . .. r .. . r.,., ' ....... � - . �
.�I. „� .
, , .,. . .. ... .. ... . . .. .... .;�. :. �. . � ... .�...�, :
. . ' : . '...,� � ..I.. � .
, . .. . .. . ..,.. . ........... . . �, . .. .."'"" _. , . ' _ WftW
+�11 .. 5... ... ' ' � � �.' ,
. . , .... . _�.. . ..I ...y
,.........._... _._.... . . _. .. . . . . . . . �� ' ,
�,
,... . ..... . .. �
. .. .:..��. .... , . _ ��LY
[OYlY1Y � .. I ' . ,....:.. . ....�,.. i . . .t.
I
..,_....... .... .,..._. ....... . , • � . � �
.,........ .... ... �.... ....... . . ' 1 '�. ..
.. '. . ... .; _..... .�.. . . -
IICwPI�n ' ,. , .. . ..... .. ....... ... ...... ...... ... . .. ... ' .,I . . .. .I . . _
. �
_.._.. �.... ....,..._.. . �
..... . ,.. ..., �
- ..... � ' � ' �� ' . i : . '. : . ',fD �
, ... ...... .. ........ ,. .
,� .. . ,.,_.. . ..__. . .,........ .. .... ....... ,... . , .
�c ' .. I, . , i .�, ,
...__.._..._..._._..._._ ......_......., ., . .. �,
. � . . ,.......: � ;�
,.. ... .__.... . ,_ . . . . , .. ,
.. . _...__ . , . . � p,..�
. � ......' .... �.,� ., � � ' ,:. '.
,. ' � • ' I I � .
1lr1M . . ..._......... ....� .�... �... . . . � .
. ._ ....... . . .. ...._._... . . , . . � :-
.._ ... . � f . , . �.
� i I i :
: i : '
,._...... .... ` , � I �. �' � �. ,,
. ... ..�
. ._. „.._...... ....................._,. .. ...... . . .
. . 7JOlYMO�
_._ , '
o�W10Y � '� ........ . . I , I
.. i . ... I I._ . ..�. ..�. M�fb1
. .. . ..,..�..._. ...._._.... ....� .... .. . .... , ' . . : ,
' I I
.. . ... .. '.. . . .... .....i . :...... �....1. . ._..1..�..,.
� .
...... .. .............. ..... . .......�. •• ; . :
... . ....� . ..,... . ' ..... .. '.. ...II_ �.. ! ..��_�. � OfIO.IO[
.l. .... '....... � ..;..!.I � ' � •
/
�M �YINyIM 1 ' � — �.
• . .w.. � �U.JY
. .,. .... . . .. . ... .
Yf4/�IIOVIIMTW� Osy.ww IS�Oi'YwnYMnSUM1'L`r��.w.{qyyy�.�^J�7WtW�C44i�1'/Altl] TVriW IIwtlNO
. .... .. _....... ..... . "
�o� �
•f01YWP� ]oWl]OINr �❑ • I � �. I
1
icwep I "�
w�+r.�n. xwmow �l7 ' .
ee�.a� . I •�
�ue�.,.,. »vyman "'^'0 I
uo+...i�swo� ro:nn +9Yi uvetlr acn s,w �aa WY�1aioC wn -- I
� 'S]�fiwxYlq
I �
�nn.�� �rnn�aurntOlw��envmyi�av�lrcWw� r�Ownima 7mr�wYnnaan�on�� e..rwm:3n �n�
�. �0�»•p�n�eu-a�ewiopunMn^►a410ULYd31.�1Y3H1A�uoMOla3ew31iltl
""' �'^° vne,wv�avaw ao�SflB�QOH70'3171117A NDlOW lYp�/Iq]V�/flDAYllY�prjpY 3
�Oe rnrr. OnM �700NKN � •!qu9� aav.K unx�rn c Ma
� 6L8££6IOo Z.L'I�IftS'd;) 3AI5S�2��J02�d
' � � IiL+Nnv�wnw prn.rhWw+ I �py�jy �
,�r 1'� TU si0 r:�ri a8N68S zo
naaw �w.u' � u.w. p°�'. O�WJA oW�o �irv4 ""1°' r.�a.,�..�.�w� ssLw. v�u I •�ri�. �+o
�,� � n.,. �„ x�9 TO � Stta >1'IOn �0
, �� FCJ Iw4 liVn OI�II A�OVA
,�,.,,, „a„ ,,.,;,, LO i91, ZiOSS NW 'xSi� 21 �N3:1 i0
�aaauc'iw wiv�e 3c7rv49' '7q�lk�
ww•, c,� ,�� �� 3ntt N'3'INZRO 40�E �0
-� N Z,LZff H�S 'T?ZNFf(1 023FAt �0
.v�o ,u �� _
ou�¢ +*as
�++D
.x�.�� �� ` �:u r,��. 'j�o 't[ 86 � B'b �l
�N����YW4 K0101 ]tlN h'tlO 1�i •M�V W 1�Mtlf��Yr^tW� itlDl:/A� .�O�IDi i�y s�y �yry
ar�v�u �m� � amn iam�m �m�DS �� N� �D ga�aw t4aoOa3i� D3G5 �i.ae � � T0.
z�4oss xs��y ,,N� Yn
�11VL'�ia�
� ����1D mv�t
Nw.« TO Lt1 �!�'d Nt?'INIO� 809E' �iT
��.. �
,.m,,, ,,,,,,,�,�,,, ZL-l.G-Oi zd,'I(1fi�S 7�SIPITdd 1��3H`3; '
tm.n�a�n croa«ti uw�,oauo I tun�rna.�aut�n :�au�
�nn.� snu�nn s�vn un� TO A NW $T�6966GL7.Z9LA TO'. �
+•�.arW�ww��w wnm, ou��c wro u.v I ��meaw�cwa,
•_'+
�LL�/YO1w+1 ) �c'raufOY �ARfuw .xW7DVlaO1 Rmll! � � 'uO �
O ��;�7 ^� ^�—.� p ��K{Ma Mu M OY Nq]
{J !�
W �y 9M11 iLl{�WY11rIM
IOL•J.�
� � � �� •.YNf n,3vni U I 1 I � I' (
@TM ' . .filUMf �
O J,� VBZ. Db T
� � ,
Received Date: 06/17/2015 '
�«�^ . �;�� �'��'1919i�� �"'`;T �� ��g�sr �'�A�b�.: „�� ��,_.;�.
�, � �� ,� �"'�ul��'�i'��� �� '�IV}p ��I'I i i;�pCili'il'i li��r�v� �,.. � , "`�
a � � I'lil I III II�I �` � -
��:
�ii
�� �
� _; �
,;� ,�
`g ' �,
� ,
�, ^-'
� i '
r
�
�� � � i —
6 � ��� `T• _�
m.:e�
� e � ��'���y".
�
�.
� t �t�,y _.
w��
��ti` .,�� � ��� �
:�,
u+"''
��� �
��`�
�I�,I
� ��
li �
� ��R _
�
�
�
.� .� ���� � .. �
� . _
_ , .
M o-,�- � � „ � > '�,
�� ;�, �
� ; r � � �
�� � r
... . 'y-„ p =K� ..�. '^., .
- . � `�`:. �� . ..
f � �� t
� � �' .. i YS.�
� T4
}
3 Y^s
�sg�°� �: ..
�[�
&
. . �'r .�.�.
t� y
. , 4`;;_ ..1 �� .
. � �$,� � i� - �� '
� �
Z
�
3 ��
... .° 4-ex-4,..�
} �
�
� .�
J
�$ .... � � . �{^� . .
�'.� �. . �.� � ..-. . .
.a r �� � � i. � � �""�'� i w������ �'e�� ���..� ,.I��il A�I����I��'
� �� .k� �`_� �� � _ �
��`�c �` �� f:�= ���9��4i
. � �k �, i i i „t,�` �V���,' _ _� �
- � ���� � �� �� I I�M�I�I��II ���.
�I�. i �9 �
�''� � _
�p '� �=
� � '� �°
��- `�
� �
,� ��
,� �
°��
w
��
� `�. ��
- �� i�'���'��
�
�
�� �
��
� �� �
����
� � ,� � � _
� ��,'�� � s;, ,
�� �'�
� � -
� �_":�-�� �k
a�� ���� � �.
���� V ��.
�}ki.
- ��:_ � `:�-. �
�
�:_.�,
>
`;;�`
_ �. _,
F': . w ��T 3.�?i� t�_ t ..�
�
>
r� t
��
�
�, °
� �z3�. +'' . . .
".3. � ��:'"_., � .
�,�
�s
}{ _
_ �.} � �
�.FB �"�
�
�'''_� ,U
vZ
s " '1,3 i,�.;
� .
���
��_.
�`,� �
��:£_`: . . �
r�k.
��-',. . � � .
�.�.ts.� ' . . .
�1�.
,�
�� ,�¢
: §
��. ,,�
, �
�-� ��
=�e;
��I�I T�z
r ,
j �,,
a
�- �
1 �
� •• _
� • ~ �;.'
;;
�� �
,�� �
�}. � ��:
�# �
jv
i
��-, .
� ; �,' � �